Pediatric CCRN Exam Cheat Sheet 2026

The 30 highest-yield Pediatric CCRN Exam facts, distilled from real exam questions. Print it, save it as a PDF, or study it here — free, no sign-up.

1. A 7-year-old with burns covering 40% TBSA is in the acute resuscitation phase. Using the Parkland formula, how much fluid should be given in the FIRST 8 hours? → 50% of the total 24-hour calculated volume
2. Which opioid is CONTRAINDICATED in a child with renal failure requiring pain management in the PICU? → Meperidine
3. A neonate post-cardiac surgery has a central venous pressure of 18 mmHg, decreased urine output, and hepatomegaly. These findings are MOST consistent with: → Right ventricular failure
4. A 4-year-old with burns over 40% TBSA on day 2 of hospitalization has brown urine, rising creatinine, and serum CK of 25,000 U/L. The PRIORITY intervention is: → Aggressively increase IV fluid rate to maintain urine output >1–2 mL/kg/hr
5. Which arterial blood gas pattern is consistent with acute respiratory acidosis in a pediatric patient? → pH 7.28, PaCO2 58, HCO3 25
6. Which acid-base disturbance progression is most commonly observed as chronic kidney disease (CKD) advances in children? → Non-anion gap metabolic acidosis progressing to elevated anion gap metabolic acidosis
7. The nurse's initial step in treating a patient who has hypovolemic shock as a result of persistent vomiting should be to: → Administer oxygen
8. When calculating percent fluid overload in a PICU patient, which formula is correct? → (Current weight − admission weight) / admission weight × 100
9. A 10-year-old PICU patient from a non-English-speaking family requires consent for an emergency procedure. The nurse should: → Request a professional medical interpreter for the consent process
10. Which of the subsequent interventions would be most beneficial in helping to manage a child who needs PEEP of 14 cm water? → High-frequency oscillatory ventilation (HFOV)
11. When interpreting a pediatric 12-lead ECG, which finding is most concerning for Wolff-Parkinson-White (WPW) syndrome? → Short PR interval with a delta wave
12. A 6-year-old with ARDS is on mechanical ventilation. Lung-protective ventilation strategy includes tidal volume of: → 6–8 mL/kg ideal body weight
13. Which of the following describes the fat embolism syndrome (FES)'s most typical showing feature in children? → Pulmonary manifestations
14. Which of these is a sign of leukemia? → Anemia infection
15. In a child with acute hypoxemic respiratory failure, which oxygenation index (OI) value meets criteria for pediatric ARDS (PARDS)? → OI of 10
16. Which corticosteroid dose is recommended for physiologic stress dosing (adrenal insufficiency coverage) in a critically ill child under 10 kg? → Hydrocortisone 50 mg/m² /day (stress dose: 3–5× maintenance)
17. What does the air lack in terms of breathing? → Respiratory arrest
18. A 5-year-old post-extubation develops stridor and increased work of breathing within 1 hour. The MOST appropriate initial intervention is: → Racemic epinephrine nebulization and IV dexamethasone
19. Which of the following would cause a newborn who had recently undergone cardiac surgery to lose more fluid without being aware of it and develop hypovolemia? → Radiant warmer use
20. A 6-month-old post-operative Norwood procedure has a central venous saturation of 40%. What does this finding indicate? → Imbalance between oxygen delivery and consumption
21. A nurse is caring for a neonate with suspected hypoxic-ischemic encephalopathy (HIE). Which intervention is most important to initiate within 6 hours of birth? → Therapeutic hypothermia (33–34°C)
22. A 4-year-old on ECMO develops circuit clotting. Which lab value BEST reflects adequate anticoagulation? → Activated clotting time (ACT) of 180–220 seconds
23. A 4-year-old presents with bloody diarrhea, thrombocytopenia, microangiopathic hemolytic anemia, and acute kidney injury. What is the most likely diagnosis? → Hemolytic uremic syndrome
24. A 3-year-old with bacterial meningitis develops a petechial rash, hypotension, and purpura fulminans. Which organism is most likely responsible? → Neisseria meningitidis
25. When calculating maintenance IV fluids using the Holliday-Segar method for a 25 kg child, how many mL/hour should be given? → 75 mL/hr
26. Which medication is used as a continuous infusion to maintain ductal patency in a neonate with ductal-dependent congenital heart disease? → Prostaglandin E1 (alprostadil)
27. In which clinical situation is the use of NSAIDs MOST dangerous and contraindicated due to risk of precipitating AKI in children? → Septic shock with hypotension
28. After taking prenatal vitamins with iron, a 5-year-old is receiving treatment in the PICU. The nurse assumes all of the following EXCEPT: → Administration of activated charcoal
29. A 10-year-old with ALL is neutropenic (ANC 200) and develops a fever of 38.5°C. Blood cultures are obtained. Which is the correct initial management? → Start broad-spectrum IV antibiotics immediately (within 1 hour)
30. A 12-year-old after a near-drowning has a GCS of 6. Which GCS subscores produce this total? → Eye 2, Verbal 2, Motor 2